MOGADISHU, Somalia – Farhiya, a 38-year-old from rural Beletweyne, faced a decade of hardship that began with life-threatening childbirth complications.
She gave birth without the aid of a skilled health worker. When the labour was obstructed, a potentially fatal condition, she was left with an obstetric fistula – a hole in the birth canal that causes chronic health issues, including incontinence and the social isolation that results from it.
"I was stressed, constantly worried and isolated from my community. I was living in my house as if I had some sort of contagious disease," Farhiya recounted to UNFPA, the United Nations sexual and reproductive health agency.
In Somalia, where six out of ten births occur without a skilled birth attendant, the impact of fistula is particularly severe. Women with the condition often experience not only health impacts, but also social, psychological and economic impacts.
For Farhiya, a farmer, fistula often prevented her from working or even milking animals.
Farhiya’s journey to healing
Farhiya’s road to recovery was long and arduous – but also marked by support and compassion from friends.
One neighbour raised money for Farhiya to travel to Mogadishu for treatment. Unfortunately, the $800 surgery cost meant help was still out of reach.
Hope emerged when another woman told her about a fistula campaign – a major community outreach effort paired with free fistula repair surgeries – at Dayniile Hospital. The campaign was supported by the Federal Ministry of Health, Physicians Across Continents and UNFPA, with funding from KSrelief, the King Salman Humanitarian Aid and Relief Centre.
Once again, Farhiya’s community rallied, and with their collective support she was able to travel to Mogadishu. This time, she received life-changing repair surgery.
Maternal health in Somalia
Obstetric fistula affects millions of women around the world, and in the Arab region, women in Yemen, Somalia and Sudan are most affected.
But fistula does not occur in a vacuum – it is the result of insufficient access to basic and essential maternal health services. And the maternal health needs in Somalia are staggering. An estimated 171,000 pregnant women are struggling to access life-saving maternal health care, and four in ten pregnant women do not receive antenatal care.
The ongoing humanitarian crisis in Somalia is also playing a role. Malnutrition among pregnant and breastfeeding women has reached acute levels increasing the risk of pregnancy and birth-related complications and premature and low birth weight babies.
Amid these challenges, UNFPA and its partners are working to reach the women most left behind – the fistula survivors enduring the compounded effects of poor maternal health care, ostracism and poverty.
The 12th Obstetric Fistula Repair Campaign took place in the last week of September, and led to over 100 free surgeries for survivors. Beyond the surgeries, the initiative also focuses on raising awareness about fistula, strengthening health systems, and ensuring every woman can experience safe and dignified childbirth.
Dr. Aisha Abdulkadir Abdullahi, a member of the medical team at Dayniile Hospital, spoke about the new life these surgeries can offer women.
"Most of the patients who come to us are from rural areas, and each one of them has her own story, each more painful than the other," she explained. "With the ongoing awareness and surgical campaigns, I am hopeful that the numbers will gradually decrease and one day fistula will be fully eradicated.”
Nince’s renewed connections
Nince, a 35-year-old mother of three, also lived with the pain and shame of obstetric fistula, which developed after childbirth. Working as a porter at Bakara Market, earning a meager $2 to $3 a day, her struggles were immense.
"For five years, I haven’t visited any relatives or been invited to any weddings. I was too ashamed to use public transport," she shared. Her turning point came when a friend encouraged her to seek help at the fistula campaign at Dayniile Hospital.
After her successful surgery, Nince is now healthy and at peace.
"Now that I have had the surgery and am no longer leaking urine, I have decided to visit my relatives," she says.
KSrelief has committed $1.45 million to strengthen maternal and newborn healthcare in Somalia and, in turn, reduce cases of fistula. This funding supported the 12th Obstetric Fistula Repair Campaign as well as essential equipment for operating theatres at both Banadir and Dayniile Hospitals, where mothers once faced long waits for surgeries, including fistula repairs and Caesarean sections, due to the need for vital equipment like anesthesia machines and proper lighting.
